NepMed Repository :: Browsing by Author "Sapkota, P"

Browsing by Author "Sapkota, P"

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Association of Allergic Biomarkers in Patients with Chronic Rhinosinusitis With or Without Asthma
(Kathmandu University, 2025) Pangeni, RP; Pokharel, M; Vaidya, N; Sapkota, P; Karki, S; Bhusal, M; Basnet, D; Dhakal, A; Sapkota, B; Madhup, S
ABSTRACT Background Chronic rhinosinusitis and asthma are considered under unified airway diseases which describes the shared epidemiologic and pathophysiologic relationship among the chronic inflammatory diseases of the upper and lower airways Objective To assess the asthma in patients with chronic rhinosinusitis and determine the relationship of allergic biomarkers, tissue eosinophilia and radiological bone changes in patients with chronic rhinosinusitis with or without asthma. Method Prospective study involving 74 adult patients attending the Department of Otorhinolaryngology and Pulmonology at the Kathmandu University Dhulikhel Hospital for treatment of chronic rhinosinusitis and / or asthma and for functional endoscopic sinus surgery between May 2023 and May 2024. Absolute eosinophil count, total serum IgE and spirometry tests were performed. Radiological evidence of osteitis and tissue eosinophilia from surgical samples was evaluated. Correlations between allergic biomarkers,spirometry values, tissue eosinophilia, and radiological bone changes were determined in patients of chronic rhinosinusitis with or without asthma using the Mann Whitney U test, Student t test and the chi square test. Result A positive association was observed between the radiological bone score with tissue eosinophilia (p=.018), and smoking (p < 0.001) in between the two groups. Chronic eosinophilic rhinosinusitis was observed in 39 (52.7%) patients. 15 patients with Chronic rhinosinusitis had asthma ,and among these asthmatic patients 11 had eosinophilic chronic rhinosinusitis. Mild osteitis was evident in 34 (45.9%) ,moderate osteitis in 39 (52.7%) and severe in 1 (1.4%). Among 15 asthmatic patients, 10 had moderate osteitis and 5 had mild osteitis. Conclusion A rigorous exentration of osteitic bony nidus appears necessary for successful treatment outcomes in all chronic rhinosinusitis patients and to prevent acute exacerbation in the asthmatic group of chronic rhinosinusitis patients. KEY WORDS Asthma, Chronic rhinosinusitis, Osteitis
Bedside Index of Severity in Acute Pancreatitis (BISAP) Score on Outcome of Patients Presenting with Acute Pancreatitis in a Tertiary Care Hospital
(Kathmandu University, 2023) Gurung, RB; Jaisy, D; Sapkota, P; Bhandari, S
ABSTRACT Background Acute pancreatitis is a life-threatening condition characterized by inflammation of the pancreas causing intense abdominal pain and potential harm to multiple organs. The mortality rate is 1-5% and thus requires specialized and interdisciplinary care to inhibit it. Objective To describe the bedside index of severity in acute pancreatitis score on the outcome of acute pancreatitis patients in a tertiary care hospital. Method This is a hospital based observational cross-sectional study conducted in the internal medicine inpatient department of Dhulikhel Hospital from April 2018 and March 2019. This study reviewed the medical records of the department. Result The study included 70 participants with 44 (±14) years of average age and stating common cause as gallstone (45.7%). The study showed that those with bedside index of severity in acute pancreatitis score ≥ 3 during hospital admission had significantly higher rate of organ failure (p-value < 0.05), as well as had a prolonged hospital stay (mean: 20 [±7.9] days). The mean hospital stay was 12.9 days. Conclusion Patients with bedside index of severity in acute pancreatitis score greater than three at admission were found to have an increased risk of organ failure, significantly higher chances of requiring mechanical ventilation, and a longer duration of hospital stay. KEY WORDS Acute pancreatitis, Bedside index of severity in acute pancreatitis score, Organ failure, Outcome
Clinical and Endoscopic Findings in Patients Presenting with Upper Gastrointestinal Bleeding at a Tertiary Care Hospital
(Kathmandu University, 2024) Sharma, P; Sapkota, P; Pathak, S; Lamsal, A; Joshi, S; Parajuli, S; Rajak, S; Gautam, S; Tamang, A
ABSTRACT Background Upper gastrointestinal (UGI) bleeding is a severe medical condition that requires prompt evaluation and management. Understanding the clinical and endoscopic findings in patients presenting with upper gastrointestinal bleeding is essential for accurate diagnosis and effective treatment. Objective To investigate the age and sex composition, clinical presentations, and endoscopic findings of patients with upper gastrointestinal bleeding at a tertiary care hospital. Method A total of 561 patients with upper gastrointestinal bleeding were included in the study. Data on age, sex, and clinical presentation were collected for each patient. Endoscopic findings were recorded, and the relative frequency of various upper gastrointestinal lesions was analyzed. Result The age distribution of patients revealed that 40.82% were between 15 and 45 years, 32.98% were aged 46 to 65 years, and 26.20% were above 65 years. Among the patients, 73.08% were male and 26.92% were female. Hematemesis was observed in 248 cases, while melena was present in 136 cases, and both were present in 171 cases. Recent onset anemia with positive occult blood was reported in 6 patients. The most common endoscopic finding was varices (39.39%), followed by ulcers (15.51%). Mallory Weiss tear was noted in 5.53% of cases. Conclusion According to our findings, varices are the most common endoscopic finding in individuals with upper gastrointestinal bleeding rather than peptic ulcer disease. The considerable increase in varices emphasizes the critical importance of early identification and care in high-risk individuals, as well as contributing to a better understanding of upper gastrointestinal bleeding. KEY WORDS Bleeding, Endoscopy, Esophageal varices, Gastric varices, Gastrointestinal hemorrhage, Upper gastrointestinal tract
Clinical Dilemma of Diabetic Ketoacidosis and COVID-19 Infection
(Kathmandu University, 2021) Sapkota, P; Chalise, S; Shrestha, P
ABSTRACT The COVID-19 Pneumonia with diabetic ketoacidosis is a dreadful health condition. Diabetic ketoacidosis is one of the severe metabolic complications and it can be precipitated by infection. We presented a case of 48 years female with no known comorbidities who presented with COVID-19 symptoms and with Diabetic Ketoacidosis. The case presented with elevated inflammatory markers, high anion gap metabolic acidosis with type I respiratory failure. During admission, the oxygen saturation had marked drop, later her improvement was steady followed by gradual tapering of the oxygenation. Marked improvement was noticed in the subsequent follow-up. COVID-19 infection can be precipitated by preexisting diabetes or newly diagnosed diabetes and the severity of COVID-19 infection is more pronounced in patients with diabetes mellitus, thus should be managed timely and accordingly. The scarce studies among the COVID-19 cases with diabetic ketoacidosis reflect the need for further studies for the availability of a wider range of information. KEY WORDS Diabetic ketoacidosis, Metabolic complications, Severe COVID-19 pneumonia
Diagnostic Accuracy of Drop Hydrogen Peroxide Test as a Novel Bedside Diagnostic Test to Differentiate Transudative and Exudative Pleural Effusion Against Light’s Criteria
(Kathmandu University, 2022) Vaidya, N; Sapkota, P; Chaurasia, S; Thapa, B; Bhandari, N; Bhattarai, I
ABSTRACT Background Diagnostic evaluation of pleural fluid according to Light’s criteria to differentiate between exudative and transudative fluid takes 1 or 2 working days. For rapid clinical management, especially in critically ill patients, a simpler bedside diagnostic test can be done which has similar diagnostic accuracy as that of Light’s Criteria. Objective To determine the diagnostic accuracy of Drop Hydrogen Peroxide test to differentiate exudative and transudative pleural effusion in comparison to Light’s criteria. Method A concurrent validity test was performed using a convenient sampling technique including patients presenting to the Department of Internal Medicine from January to September 2021, who had pleural effusion. Two milliliters of tapped pleural fluid of patients who underwent aseptic thoracocentesis was collected in a test tube to which one to two drops of 20% hydrogen peroxide was added. Presence of bubbles suggested an exudative type of fluid. Rest of the tapped pleural fluid was sent to the laboratory for further evaluation by Light’s criteria, which was compared with the results by Drop Hydrogen Peroxide Test. Result There were 83 patients who had pleural effusion, of them a total of 43 patients had transudative pleural effusion while 40 patients had exudative pleural effusion based on Light’s criteria and 37 patients had transudative pleural effusion while 46 patients had exudative pleural effusion based on drop hydrogen peroxide test. Conclusion The drop hydrogen peroxide test allows cost effective and prompt evaluation of the type of pleural effusion is exudative or transudative, thereby making it a convenient diagnostic bedside test. KEY WORDS Diagnostic tests, Exudates and Transudates, Hydrogen peroxide, Pleural effusion, Thoracocentesis
Epidemiology of Critically Ill Patients in Intensive Care Units in Dhulikhel Hospital, Nepal: a retrospective observational study
(Kathmandu University, 2025) Kharbuja, K; Ranjit, S; Aryal, D; Sapkota, P; Paudyal, G; Bajracharya, A; Pasachhen, S; Bhusal, S
ABSTRACT Background Critical care involves the management of acutely ill patients at risk of organ failure. The burden of critical illness is a major public health concerns, particularly in low and middle income countries like Nepal where access to intensive care services is limited. Objective To identify the clinical profile of patients admitted to the Level III Intensive Care Unit at Dhulikhel Hospital. Method Data over a period of six months were collected from the ICU registry. Severity and mortality risks were assessed using APACHE II and eTropics scoring systems. Clinical profiles and outcomes were analyzed using SPSS version 25. An independent samples t test was used to compare continuous variables between two independent groups. A p value < 0.05 was considered statistically significant. Result A total of 486 patients were included in the study, of whom 57% were male . The median age was 55 years (IQR: 41-69). Most patients were admitted from the emergency room (52.7%). Patients with medical conditions had a higher ICU admission compared to surgical patients. The majority of patients (63.6%) were transferred to the ward followed by discharge to home (16.2%). Non routine discharges included treatment withdrawal in 89 (18.3%) and patient leaving against medical advice 53 patients (11%). The overall mortality rate was 11.3%. Conclusion This study shows that most admissions were male, with median age of 55 years and medical cases were more prevalent than surgical cases. The observed mortality rate may underestimate mortality due to high rate of treatment withdrawal discharges. KEY WORDS Critically ill patient, Epidemiology, Intensive care unit, Outcome
Nitrobenzene Induced Methemoglobinemia with Paroxysmal Atrial Fibrillation Treated with Single Volume Exchange Transfusions
(Kathmandu University, 2022) Sapkota, P; Vaidhya, N; Bhatt, S; Shrestha, P
ABSTRACT Methemoglobinemia is a potentially fatal condition if left untreated. Conventional treatment of nitrobenzene induced methemoglobinemia dictates the use of methylene blue, which is the antidote of choice. However, its availability in our setting is limited only to the laboratory use. We present a case of a 21-year-old female with intentional ingestion of nitrobenzene. Clinical history and supportive investigations revealed methemoglobinemia and it was successfully managed with single volume exchange transfusions in absence of specific antidote. While exchange transfusions are indicated for severe cases, it may be useful as an alternative treatment in acute life-threatening conditions where methylene blue is not available. KEY WORDS Exchange transfusion, Methylene blue, Nitrobenzene, Whole blood
Rickettsial Infection amongst Febrile Illness Patient in a Tertiary Care Hospital: A Retrospective Cross-sectional Study
(Kathmandu University, 2022) Gurung, RB; Sapkota, P; Bhatt, S; Tamang, A; Joshi, S; Khadka, S; Jaisy, DN; Chalise, S; Shrestha, P
ABSTRACT Background Rickettsial infection is an emerging neglected tropical disease in the Southeast Asia. In past few years Nepal is also reporting escalating prevalence of rickettsia. The under evaluation is resulting it as undiagnosed or are simply labeled as pyrexia of unknown origin. Objective To find out the prevalence of rickettsia in a hospital setting, assess the socio- demographic and other relevant clinical features of the rickettsia patients. Method This is a hospital based retrospective cross-sectional study from October 2020 to October 2021. This study reviewed the medical records of the department. Result The study included 105 eligible patients and the prevalence rate was 4.38 per 100 patients. The mean age of the participants was 42 years, and the mean hospital stay was 3 (SD ±2.06) days. More than 55% of the participants had fever for less than or equal to 5 days and 9% had Eschar present. Vomiting, headache, and myalgia were the most common symptoms and hypertension, and diabetes were the common comorbidities. Pneumonia and the acute kidney injury were the two complications of the patients as stated in the study. The severity of the thrombocytopenia deducted from admission time to discharge, and the case fatality was 4%. Conclusion The future studies shall consider on collaborative clinical and entomological research. This would help in better understanding of the etiology of supposedly unknown febrile illness and the under-investigated field of emerging rickettsia in Nepal. KEY WORDS Eschar, Febrile illness, IgM titer, Rickettsia, Thrombocytopenia

Browsing by Author "Sapkota, P"

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